One hundred frail and elderly patients with calcific aortic stenosis have been given a new lease on life with a minimally invasive heart procedure being performed at Macquarie University Hospital.
Transcatheter Aortic Valve Implantation, or TAVI, is a relatively new procedure in Australia. However, Macquarie University Hospital surgeons have now performed 100 of these, giving them significant experience in this complex procedure.

"This is a pioneering program for New South Wales and for Australia, for people with a life-threatening condition who would otherwise not have a treatment option,” said Associate Professor Martin Ng, interventional cardiologist who was instrumental in setting up the TAVI program at the Hospital.

“It's really revolutionary in terms of the quality of life improvements it can offer, and the number of lives it can save. These patients come to us with such shortness of breath that they can’t go about simple daily tasks. Their quality of life is very poor.”

Associate Professor Ng performs the TAVI procedures at Macquarie University Hospital along with Professor Michael Wilson, and Macquarie University Hospital remains the only private hospital in Australia with a full TAVI program. The team’s achievement of 100 procedures demonstrates that TAVI is now a well-established program at Macquarie, made possible through significant investment by the Hospital.

The procedure is complex and requires extensive resources in technology and staff to ensure good outcomes. Indeed, Macquarie established its program on the foundations of a comprehensive service, with its the Structural Heart Teams offering extremely detailed review and assessment, and a full MDT meeting every two weeks to discuss each patient in-depth.

All tests and procedures are available to the patient ‘under one roof’ and the care is streamlined and coordinated by a dedicated. Clinical Nurse Manager and Clinical Nurse Consultant.

“We arrange everything needed for their initial assessment on the one day at the heart care centre,” said Clinical Nurse Manager Wendy Fraser. “Then, all the screening tests required at the hospital are again arranged for them on a single day. We really have refined the way we work as a TAVI team, and things now run like clockwork.

“I think our 100th procedure is a real milestone for us.”

Associate Professor Ng says that the link between the number of TAVI procedures performed and patient outcomes is clear.

“Data from the STS – the Society of Thoracic Surgeons – and the American College of Cardiology on transcatheter valve therapy in the US clearly demonstrates that the greater a surgeon's experience with TAVI, the better the patient outcomes,” said Associate Professor Ng.

“With Macquarie University Hospital having completed 100 TAVI procedures and with our data showing excellent patient outcomes, the Hospital has clearly become a centre of excellence in TAVI in Australia.”

by Dr Jason Kaplan

When it comes to cardiovascular health and longevity, nothing is more powerful than engaging in the simple daily activities that help people live longer and the evidence to support this is now very robust.

For people who have two major cardiovascular risk factors, the risk of having a cardiovascular event increases significantly. However, for people who have what’s called “optimal risk factors”, the risk of having a major cardiovascular event up to age 85 is actually less than 10%.
When we talk about optimal risk factors, we’re talking about the big seven:

1. Non-smoker

2. Blood pressure less than 120/80

3. A healthy diet score

4. Cholesterol is less than 5 mmol /L (ideally without medication)

5. No diabetes

6. Not overweight- A healthy BMI

7. Exercise more than 150 minutes a week.

The point is that these factors are all lifestyle-related; there are no drugs involved. In fact, perhaps it’s time to return to a more hunter-gatherer sort of lifestyle and a diet high in fruit, vegetables and nuts. They had omega-3 fatty acids. They ate lean protein. They drank water and they incorporated physical activity as part of their daily routine.

Such an approach,
however, must be in conjunction with low calorie intake, as the now well-known consequences of obesity include heart attack, stroke, diabetes, high blood pressure and depression. Every five kilograms people are overweight hastens a heart attack one and a half years earlier. Every five kilograms at age 21 increases the chances of someone dying before 90 by 10%.

Reviewing the American national weight control registry, for people who lost 15 kilograms and kept it off for more than a year, it’s apparent that almost all of them cut their calorie intake in half. Over 90% exercise for an average one hour a day, 75% weighed themselves more than once a week and kept track of where they were and a large majority of them watched TV for less than 10 hours a week. These are simple, practical steps that almost any patient could take.

1. FOOD

It’s becoming clearer every day that food is one of the most powerful tools for keeping the body (and especially the heart) in optimum condition. Recent literature suggests a Mediterranean style diet reduces the risk of cardiovascular events by up to 40%.

While our bodies are not all equal, there are some fundamentals:

• Eat five serving of vegetables, two servings of fruit per day.

• Eat more fish. The DART trial looked at dietary interventions in 2,000 people who had prior myocardial infarctions. People eating at least two servings of fish a week, reduced their risk of having a subsequent event or death by close to 30%. In fact, it appears that one of the best types of diet we could recommend to someone is the ‘pesce-vegetarian’, which is primarily vegetarian with two to three servings of fish weekly.

• Eat less red meat. People who have a large amount of red meats had a 15% increased risk of having cardiovascular events.

• Avoid sugar-based drinks.

• Have a little dark chocolate. While good chocolate is often high in saturated fats and contains caffeine, there is a study that shows it does lower blood pressure and that the flavonoids in chocolate may lower LDL cholesterol. It also improves mood and happiness – which is important for longevity!

2. SUPPLEMENTS

While it’s better from the plate than from the bottle, here are a few to